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Prior Authorization Codes Released for 2017 Implementation

Last year it was announced that CMS will be implementing prior authorization on select durable medical equipment. Now that CMS has introduced this list, which can be viewed here, it means that there will be two phases of requirements for prior authorization as a condition of payment.

Phase one begins March 20, 2017, and includes the states of Illinois, Missouri, New York and West Virginia. Phase two begins July 17, 2017, expanding to the rest of the states.

The HCPCs codes are focused on mobility as the HCPCs codes included are:

  • K0856: Power wheelchair, Group 3 standard, single power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds.
  • K0861: Power wheelchair, Group 3 standard, multiple power option, sling/solid seat/back, patient weight capacity up to and including 300 pounds.

At some point, the DME MACs will be giving detailed direction to the supplier community for further instructions on processing. VGM will continue to monitor these developments and pass along information as it becomes available.